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Membership Application

Thank you for your interest in joining Hershey Volunteer Fire Department. Please complete the membership application form below.

Once submitted, a member of our Membership Committee will review your application and contact you for further steps.

Required   Indicates Required Field
Position Applying For: Required Fire Crew
Fire Police
Support Member
General Information
Full Name:
Last, First, Middle Name
Required
Social Security Number:
Birth Date: Required
Drivers License Number: Required
State of License: Required
Address:
Street Address, City, State / Province, Zip Code
Required
E-mail Address: Required
Phone Number: Required
Alternate Phone Number:
Current Employer: Required
Employer Info (Current):
Name, Address Phone Number
Required
Can you leave work for Fire Calls: Required No
Yes
Name of Supervisor: Required
Normal Work Schedule: Required
Emergency Contact Name: Required
Emergency Contact Phone Number: Required
Education History
Do you have either a High School Diploma or GED: Required No
yes
School or Training:
Please include any colleges or any other schools attended.
Required
Special Qualifications:
Licenses, skills with machines, other Fire Department memberships or related archives
Work History
1. Name of Employer:
1. Address:
1. Supervisor Phone Number:
1. Job / Duties Performed:
1. Reason for Leaving:
2. Name of Employer:
2. Address:
2. Supervisor Phone Number:
2. Job / Duties Performed:
2. Reason for Leaving:
3. Name of Employer:
3. Address:
3. Supervisor Phone Number:
3. Job / Duties Performed:
3. Reason for Leaving:
Prior Residences
Address 1:
Street Address, City, State / Province, Zip Code
Address 2:
Street Address, City, State / Province, Zip Code
Address 3:
Street Address, City, State / Province, Zip Code
References
Please list three persons who are not related to you and who have definite knowledge of your qualifications or fitness for membership. Do not use names of supervisors you listed above as we consider them references, unless otherwise noted.
1. Full Name: Required
1. Phone Number:
2. Full Name: Required
2. Phone Number: Required
3. Full Name: Required
3. Phone Number: Required
Criminal History
Have you ever been convicted of a crime? Please include any misdemeanor or felony convictions: Required No
Yes
If yes, list date of offense, all charges for which you were convicted and the disposition:
Medications
Do you have any medical conditions or medications that would prevent you from your duties for the position you are applying for: Required No
Yes
Authorization for Release of Information
Enter your full name which signifies your understanding and approval of the above statement: Required
Submitted on : Required 10/18/2024 0222
Resume / File Upload:
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I authorize the Hersey Volunteer Fire Company to conduct an investigation into my background, including but not limited to anyrecord of Criminal Arrests which may exist, and to the release to the Hershey Volunteer Fire Companyany and all information obtained as a result of such investigation.

  • I further understand that this investigation will be confidential and findings contrary to theinformation provided on the application may subject me to prosecution under the Pennsylvania crimescode for unsworn falsifications (18 PA. C.S. §4904). I understand that the information will be released tothe appropriate officers of the Hershey Volunteer Fire Company when the investigation is completed.

  • I verify that the information setforth in this application is true and correct. I understand that any falsification contained in this application shallresult in denial or termination of membership. This verification is made subject to the penalties ofsection 4904 of the crimes code of Pennsylvania(18 PA. C.S. §4904) Relating to unsworn falsifications.





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Hershey Volunteer Fire Department
21 West Caracas Avennue
Hershey, PA 17033
Emergency Dial 911
Non-Emergency: (717) 533-2953
E-mail: info@hersheyfire.org
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